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Miniseminar Addresses Basics of Cough Science


Jonathan M. Boch, MD, speaks about pertussis during a session on chronic cough as other presenters Robert J. Stachler, MD, and Kenneth W. Altman, MD, PhD, listen.

Three speakers broke down the complications associated with cough during the Miniseminar “Cough: Contemporary Challenges,” supported by the Airway and Swallowing Committee, which took place September 24.

Kenneth W. Altman, MD, PhD, spoke about “Neurogenic Cough: A Physiologic Model,” Robert J. Stachler, MD, addressed “Reflux and Cough Update,” and Jonathan M. Boch, MD, covered “Bordatella Pertussis: An Emerging Cause of Chronic Cough.”

“The objectives are to become familiar with the multiple etiologies for cough and its management, to understand more completely the complex relationship between the cough receptors and the larynx, to become knowledgeable of whooping cough’s resurgence and management, and certainly I wanted the participants to be able to take home new management strategies and techniques to deal with cough,” said Dr. Stachler, who moderated the session.

Dr. Stachler spoke about chronic cough, presenting to attendees the etiology, some case studies, new data and practical management tips.

“The chronic cough is a conserved physiologic reflex that protects the airway from inhaled or aspirated materials,” he said. “There’s a different pathophysiology overall than with the acute cough. It is the most common presenting symptom to ambulatory medical visits in the U.S., at 3.1 percent.”

Chronic cough, he said, is defined as a cough that lasts longer than eight weeks. It affects about 20 percent of the adult U.S. population. In the United States, $3.6 billion a year is spent on over-the-counter medications for cough.

Patients who stop smoking often experience relief of symptoms. Air humidification and water intake are encouraged, Dr. Stachler said. Antibiotics can be effective, including when sinusitis is a factor. Antihistamines, pseudoephedrine, asthma corticosteroids, leukotiene inhibitors, and inhaled or oral steroids also can be used to treat chronic cough.

Dr. Boch addressed pertussis, or whooping cough, which he described as a complicated issue for ENTs.

“Usually by the time patients see you, as the ENT, they’ve seen multiple doctors, they’ve had a full evaluation and multiple other tests, and sometimes endoscopies,” he said. “Your job as the ENT is to listen to their history, listen to their story about why they’re coughing and when they’re coughing, and try to come up with a plan that maybe finds out what that hidden issue could be.”

Dr. Boch shared the case of his wife, who had an intense cough that worsened over several weeks. She was diagnosed with pertussis.

Pertussis was a major killer of infants in the United States before widespread vaccination efforts began in the 1940s. However, there is a resurgence of the disease, especially in California. There were 17,325 cases in the United States this year—a 30 percent increase from last year. California has seen 7,980 cases so far, resulting in 267 hospitalizations and three deaths—all infants younger than 2 months old.

As fewer children are being vaccinated for pertussis, there’s also an increase in adults being diagnosed with whooping cough, Dr. Boch said.

“There’s a spike in incidents around the country,” he said. “We, as people who see people with chronic cough issues, should be aware of what pertussis does to adults. In kids it’s a bit more clear, but with adults—you’re going to see these people come in.”

Dr. Boch suggests continuing to recommend the full course of immunization and recommend all adults get the booster DTaP. Infection is still possible after immunization.